Treatment exists for heavy menstruation

Washington -- A patient of Michigan obstetrician-gynecologist Elisabeth H. Quint, MD, wore black five days a week. Black, she reasoned, would better hide any embarrassing blood stains that soaked through the various layers of protection she used during her very heavy menstrual cycles.

But the 36-year-old patient also could have been wearing black to mourn the loss of a normal life. Although menorrhagia is not fatal, women with the condition face fatigue and anemia caused by blood loss as well as embarrassing incidents that make them reluctant to leave the house and cause them to severely restrict activities.

Excessive menstrual bleeding affects approximately 10 million women in the United States each year, according to a national survey conducted for the National Women's Health Resource Center, a nonprofit information source on women's health issues. Many accept this condition as a normal part of being a woman and are reluctant to raise the issue with their physicians. But it's not normal, said Dr. Quint, who also directs a Hysterectomy Alternatives Program at the University of Michigan.

Physicians should ask women, especially those who are anemic, the length of their monthly cycles, how much they bleed, and whether and how it affects their lives, Dr. Quint said.

"This condition restricts women in the most personal ways, from their sexual activity to spending quality time with their families and friends," said Amy Niles, president and CEO of the NWHRC. The resource center and the Jacobs Institute of Women's Health in Washington, D.C., co-sponsored a Nov. 15 Capitol Hill briefing on abnormal uterine bleeding.

The center's national survey found that 58% of the 653 women queried had not discussed the condition with their physicians or other health care professionals. Many of those who sought help had tolerated the difficulty for at least five years before asking about treatments.

Multiple options

And there are several effective treatments, Dr. Quint said. For example, taking a nonsteroidal anti-inflammatory drug, such as ibuprofen or naproxen, can be a good first step. If taken throughout a woman's monthly period, NSAIDs can reduce blood flow by as much as a third, she said.

Hormones, whether estrogen and progesterone, or progesterone alone for those for whom estrogen is too risky, such as smokers, also can be used. But they must be taken at about the same time every day, creating a high potential for forgetting, she said.

The insertion of a progesterone intrauterine device also can significantly decrease blood flow, she said, although it is recommended only for women who have completed childbearing.

If those treatments do not achieve satisfactory results, endometrial ablation can be tried, Dr. Quint said. But the procedure isn't for everyone. Women who have many uterine fibroids might find that it doesn't work, and it is only for women who have completed their families. Still, "the procedure can reduce bleeding by as much as 80%," she said.

Uterine fibroids are a major cause of excess bleeding, although why this should be is a puzzle, Dr. Quint said. Some women who have fibroids have no symptoms, while others do. Fibroids are most frequently a problem for women in their 30s and 40s. Also, black women are more likely to have them than are women of other races.

Uterine artery embolization can shrink the masses and reduce bleeding. But the downside to the procedure, Dr. Quint warned, is that it is very painful for the first 24 hours as the fibroid tissue dies.

Hysterectomy has been a common solution to the problem, and it is a successful option for many women. But some would like to avoid having the surgery and might postpone a discussion with a physician because the option might be suggested.

This was the situation related by Joan LaRock, 52, from Virginia, who spoke at the briefing.

LaRock was seeking an alternative to a hysterectomy -- an option that seemed inevitable because her two sisters, including her identical twin, and her mother had all had the operation to resolve heavy bleeding.

After trying other treatments, her physician suggested endometrial ablation to remove the lining of her uterus. Monthly bleeding is now manageable, she said. "One year later, I'm functioning again."